Quality Assurance Coordinator (32273)

SUMMARY

The Clerical Quality Assurance Coordinator is responsible for handling various tasks related to client reports including, but not limited to: receiving, coordinating, assigning and returning completed reports to clients. This position works closely with the clinical quality assurance team and ensures work is processed and completed of the highest quality and in compliance with all policy and procedures.

ESSENTIAL JOB FUNCTIONS

• Receive client submissions and input client and examinee data in the system.
• Verify all cases contain information needed for the clinical review process.
• Maintain daily contact with the Clinical QA Department regarding workflow and status of pending reports.
• Track documentation of all processes, communications, report status and due dates.
• Maintain a daily log of files that require follow up, clarification or concerns in the tracker.
• Receive completed reports and review for completeness and accuracy, including proper formatting, grammar and sentence structure.
• Complete and or ensures all invoicing is billed daily and in accordance with company practices and client contract agreements.
• Handle and respond promptly to incoming communication from physicians or clients requesting report status or information.
• Work with transcriptionists and/or physicians' offices regarding report details, clarification, addendums, etc.
• Ensure all medical records and reports are properly documented and saved in the appropriate location.
• Notify management of any report issues or concerns.
• Ensure all practices are carried out in accordance with HIPAA compliance practices, state and federal safety standards and legal regulations
• Promote effective and efficient utilization of clinical resources and supplies.
• Perform other duties as assigned.

MINIMUM REQUIRED QUALIFICATIONS

Education and/or Experience

High school diploma or equivalent required. Two years IME or medical experience preferred. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability preferred.

Certificates, Licenses, Registrations

No specific requirements.

ESSENTIAL COMPETENCIES

QUALIFICATIONS

• Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
• Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
• Must be a qualified typist with a minimum of 40 W.P.M preferred.
• Must be able to operate a general computer, fax, copier, scanner, and telephone.
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Must possess excellent skills in English usage, grammar, punctuation and style.
• Ability to follow instructions and respond to upper managements' directions accurately.
• Must demonstrate accuracy and thoroughness. Look for ways to improve and promote quality and monitors own work to ensure quality is met.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Must be able to work independently, prioritize work activities and use time efficiently.
• Must be able to maintain confidentiality.
• Must be able to demonstrate and promote a positive team -oriented environment.
• Must be able to stay focused and concentrate under normal or heavy distractions.
• Must be able to work well under pressure and or stressful conditions and must possess the ability to manage change, delays, or unexpected events appropriately.
• Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.

LANGUAGE /COMMUNICATION SKILLS

• Ability to read, analyze and interpret common correspondence, medical records, itemized billing statements and/or legal contracts and documents.
• Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.
• Ability to respond appropriately and professionally to all inquiries or complaints from clients, physicians, upper management, regulatory agencies, and/or members of the business community.
• Ability to effectively present information one-on-one, in small groups, and/or clients or vendors of the company.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This is generally a sedentary job position that consists of:

• Ability to work at a desk or similar office-type furnishings up to 8 hours a day or longer as required by business needs.
• Ability to operate a computer up to 4 hours at a time.
• Ability to travel to different floors of the office or other locations.
• Ability to move throughout the office.
• Occasionally lifting and/or carrying up to 10 lbs.
• Occasionally pushing/pulling up to 10 lbs.
• Occasionally subject to bending, squatting or twisting.

About Us:

AllMed provides clinical decision making and utilization management solutions to leading payer and provider organizations. We work closely with your team toward a shared vision of healthcare that delivers the highest quality, values patient experience, and ensures both appropriate care and utilization of health-related services.

Our solutions are developed and delivered by experts-they are thoughtfully designed to integrate seamlessly into your organization and help you deliver the right care to the right patients at the right time.

AllMed offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans